Trust PPO Plan Medical Benefits

Premium comprehensive medical coverage for PPO plan participants.

Premera Blue Cross (Premera) is the Trust’s preferred provider organization (PPO) nationwide. Participants have access to the BlueCard® PPO network, one of the largest national networks available.

The BlueCard® PPO network includes the Heritage and Heritage Plus 1 networks and provides for:

  • Medical services, including physician and hospital services

  • Behavioral health and chemical dependency services

  • Medical supplies and equipment

The BlueCard® PPO network of physicians and other healthcare professionals provides eligible employees and dependents with efficient, cost-effective services and supplies at discounted rates. Although you may see any provider covered by the plan, you receive higher benefits if you use in-network Trust Medical Plan providers.

For more information, visit Resources & Forms or login to www.nwadmin.com to download or view your benefits booklet.

Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association serving businesses and residents of Alaska and Washington state, excluding Clark County.

Find a Provider

Find an in-network provider by searching the BlueCard® PPO network online or call (800) 810-BLUE (2583) and reference the prefix TMP.

Preventive Care

Preventive care includes covered well-adult and well-child physicals, immunizations, flu shots and appropriate preventive screening tests like mammograms, colonoscopies, and prostate exams. Covered eligible in-network preventive care is paid in full by the Trust — with no deductibles, co-insurance or co-pays. In some cases, if you already have a diagnosed medical condition, these types of services may be considered diagnostic rather than preventive and subject to annual deductible, copays, and coinsurance.

  • In-Network: Eligible services received in the BlueCard® PPO network are covered at 100%.

  • Out-of-Network: Eligible services received outside of the network are covered at the plan’s out-of-network coinsurance level after a copay per visit and deductible amounts are met.

24/7 NurseLine

Sometimes it’s not convenient, or even possible, to talk to your doctor when you need information or answers to your questions. It’s nice to know that, even in the middle of the night or on weekends, you can call the 24-hour NurseLine to talk with a registered nurse about health concerns, determine next steps, home treatments or if you need to visit your doctor, urgent care, or the ER.

The NurseLine is available 24/7, confidential and provided at no cost to you. Call (855) 784-4561.

A nurse can help you:

  • Decide if you should go to your doctor, urgent care or the ER

  • Get answers about your prescription medications

  • Learn how to take care of certain health concerns at home

  • Prepare for doctor visits

  • Make lifestyle choices to improve your health

  • Make informed decisions about tests and procedures

  • Get health information resources and tips

  • Get printed materials on many health and wellness topics

The NurseLine is an educational resource and not intended to constitute healthcare. If you have any concerns about your health, you should consult with your physician. In an emergency, call 911 or your local emergency services number.

Pre-Authorization

Pre-authorization is the process of determining if services, equipment or supplies are medically necessary and will be covered by your Plan prior to your obtaining them. This process protects you from unexpected costs. With pre-authorization you will have the assurance that the services you receive are medically necessary and eligible to be covered by the Plan prior to incurring the expense.

Some common services that require pre-authorization include:

  • All planned inpatient stays

  • Admission to a skilled nursing facility or rehabilitation facility

  • Admission to behavioral health residential treatment centers

  • Non-emergency and elective air ambulance services

  • Some outpatient services

  • Certain organ transplants

  • Purchase of supplies, appliances, DME, and prosthetic devices over $500

  • Provider-administered drugs

Doctors who are in the Premera network can request pre-authorization for you. Healthcare providers who are in the Premera network are familiar with the process for getting pre-authorization. Be sure to confirm with your provider that they will be contacting Premera on your behalf. In-network doctors have all the medical information needed to ask that your medical service be reviewed and approved for coverage.

Medical Care Support Services

When you or a covered family member receives care from a participating Premera Blue Cross doctor or facility, your provider will arrange all the care you may need, including getting prior authorization and hospital inpatient precertification, as required.

Through Care Management, a participating Premera doctor or facility may be able to lower your out-of-pocket costs by recommending one of Premera’s preferred facilities, or by helping identify treatments or procedures that may be avoidable. This also keeps you in-network and possibly avoiding out-of-network uncovered costs.

Personal Health Management

The Trust offers participants Premera’s Personal Health Support programs to help members with such things as managing complex medical conditions, a recent surgery, or admission to a hospital. Participants work with a trained Personal Health Support Clinician, who’s primary role is to support you and your entire family through a potentially difficult time.

Personal Health Support services include:

  • Helping give participants access to health improvement resources and assistance in following providers’ prescribed treatment plan,

  • Coordinating care services as needed,

  • Helping participants to understand their coverage,

  • Management and assistance with chronic conditions, and

  • Help finding useful community resources.

Premera’s Personal Health Support teams are made up of trained nurses and other certified health care specialists. Participation is voluntary. To request help from Premera’s Personal Health Support team, call (855) 869-6775.

Pregnancy Support Services

Whether you are expecting or thinking about building a family, Premera offers a comprehensive maternity program to help ease your concerns and make sure you get the pregnancy, delivery, postpartum care, and newborn care you need. With the Premera maternity program, you have access to the following:

  • The Wellframe app – An interactive app with checklists, milestones, and articles for expecting and recent mothers. You can also get helpful reminders for appointments and medications.

  • Extra clinical support – Personal Health Support (PHS) clinician’s have the training and knowledge needed to help with any pregnancy questions – especially for moms who are over age 35, or have a history of multiple births, preterm birth, miscarriage, or complicated health conditions.

If you have a question about your pregnancy, a Personal Health Support clinician can help:

  • Download the Wellframe app, and register with access code: helpbegintpa. Once registered you can send a secure in-app message.

  • Call the Premera maternity support line at 855-756-0797 Monday through Friday, 8 a.m. to 7 p.m., and Saturday, 9 a.m. to 1 p.m. Pacific Time, except holidays.

Neonatal ICU Support
The Neonatal lntensive Care Unit (NICU) program provides case management for babies admitted to the NICU. The Network Administrator and/or the hospital refers those who are admitted to the NICU or a specialty care nursery to the NICU Program Manager. The Program Manager then contacts the parents to get consent for the baby to participate in the NICU Program. Participation in this program is voluntary.
Services of the program are:

  • Coordination of care for newborns throughout their stays in the NICU

  • Assistance with management of the baby’s care from discharge to the baby’s transition home

  • Comprehensive booklet that educates parents about the NICU and the needs of the child in the NICU

  • Measures of health outcomes

Blue365 Health and Wellness Discount Program

Premera Blue Cross members have access to Blue365, a complimentary health and wellness discount program. Members can use Blue365 to access discounts on:

  • Gym memberships

  • Fitness gear and apparel

  • Hearing aids

  • Prescription glasses

  • Healthy eating options, and more

Blue365 is free and provides year-round access to discounts on affordable solutions to support your health. And unlike some other discount programs, there’s no need to earn rewards or points in order to take advantage of these exclusive deals — you can start saving immediately!

Sign up today: Blue365deals.com/premera